A "deficiency" or mental illness?

I was discussing my blog with my father over the weekend because I was still torn over the issue of whether or not to disclose my true identity in my writing. He and I both agree on the point that there is an incredible amount of stigma still attached to the label of bipolar in our society, and then he said something that really made me think. He told me that he doesn't consider me to have a mental illness, per say, he feels that I simply have a "deficiency in my brain chemistry" which causes me to become psychologically impaired during times when I am unmedicated. Humph. Good point Dad. Especially because all three of my hospitalizations prior to the first where we had no clue that I was Bipolar, happened when I was not on my medications.

But are you saying this simply so that you do not have to be constantly reminded that your child has a psychiatric condition? I guess "deficiency" just makes it feel better.

I mean, I see your reasoning. And it does make sense. It is true that I really only require a small amount of Lithium to function at a completely normal level. So, as long as I take my meds (which I do religiously - my past has taught me some very valuable lessons, let me tell you) I'm normal. Balanced. Sane.

Not mentally ill.

History has proven for me that within a week of going off my medication, I'm spinning out of control and am clinically psychotic. It takes a couple of weeks on anti-psychotics to bring me back to the middle.

So yeah, I guess you could say that my brain is deficient. It's so weird to me that all it takes to keep me normal is a small amount of a naturally occurring salt. When I looked up Lithium Carbonate on Wikipedia, I wasn't surprised to read this:

Upon ingestion, lithium becomes widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotonin synthesis.

After my most recent hospitalization, I was released to the care of my regular psychiatrist who had been helping me try to stay off Lithium during the pregnancy since I wanted to be medication-free for the first trimester to give the heart time to form without being exposed to Lithium. At my first appointment with her post-hospital, she and I agreed to continue using the anti-psychotic, but to try to stay away from the Lithium as long as possible. That next month was really hard. I literally had trouble putting words together to form sentences. I couldn't talk right. I jumbled my speech. I couldn't write with a pen and paper. I avoided my friends because I didn't want them to see me that way. I remember telling my psychiatrist, months later once I was stabilized again on Lithium, that at the time it felt like the neurons in my brain were broken, they weren't firing the way they should have been so that I could think and make sense of things. It was awful. I needed Lithium in my blood.

I specifically remember the morning that I called my high-risk OB-GYN to tell him I had recently come home from a hospitalization. I told him I wanted to stay off the Lithium for the first trimester, but he said it sounded like I needed it. That was when I made the decision to go back on it. It was a good decision. The benefits outweighed the risks.

But back to my original topic - deficiency or mental illness? I don't know. I'm still torn on this. Bipolar Disorder is a mental illness which people live with their entire lives. Just like heart disease, once diagnosed, is a condition that a person lives with the rest of their life. Sure, there is a deficiency in my brain chemistry that when treated allows me to function at a normal level. But that doesn't mean that I don't live with this diagnosis for the rest of my life. I still think about it about twenty times a day, on an average day. And if I don't take my meds, or they suddenly stop working for me, then yes, I will become mentally ill.

It's just that 99.8% of my life has been spent not feeling mentally ill. And I'd like it to stay that way.

What's your take?

Moving on anonymously - for now

My mom brought up a good point in regards to my dilemma of revealing or not revealing my true identity here on the blog: the kids. Playdates. Would other moms not want their kids playing with mine if they knew that I had Bipolar. Wow. Why had I not thought of this? It's a sad reality in our world that so many people are so incredibly ignorant to mental health issues, bipolar disorder especially. But it doesn't surprise me. Hell, I barely knew anything about it until it jumped up and bit me in the ass. I was forced to read up on it and learn about it as fast as I could in order to get my life back in order. My husband and my parents did everything they could to help. There were countless hours spent online researching symptoms and conditions to try to confirm what the doctors were telling us about what was happening to me. My dad took me to the bookstore where we stood in front of the psychology section for a couple of hours pouring over the books on the shelves to try to find some that could help us. My mom went online and was able to find Julie Fast's Health Cards System which she immediately ordered for me. Me, well, I was just trying to keep my head above water.

Once I received the formal diagnosis of Bipolar Disorder, it was a bit of a relief to know that we had a starting point to help me begin on the road to complete recovery. That was in the Spring of 2006, and after spending the majority of that year clinically depressed, it wasn't until the beginning of March 2007 that I began to feel like my old self again. I had learned about the extreme highs I had felt, learned why I needed an anti-psychotic medication, and had also learned what it felt like to be at the lowest low on the depression spectrum and how once I found the right medication for me - the mood stabilizer Lithium - I could be completely balanced and could stay that way as long as I managed my moods closely with my psychiatrist.

When my mom brought up the point about playdates, it really made me think. And as usual for me, I can see both sides to the argument.

If I were a mom to two small children and had never been exposed to mental illness or bipolar disorder, and only knew what I heard of it on the news or in magazine stories, than yeah, I'd probably not want my kids playing with other kids whose mother had Bipolar. If I were that uninformed about the condition, I would probably think that she was a bad mother. And as my kids grew up, they would probably begin to believe the same thing, causing my kids pain by teasing them behind their backs.

These thoughts break my heart.

On the other side, there is a huge part of me that feels that if someone is so ignorant about bipolar disorder that they wouldn't be friends with someone who had the condition, then I wouldn't want to associate with them anyway.

But that is just me thinking about my viewpoint on the issue. I have to think about the future here and my kids might feel differently. I hope they don't, but I don't want to jeopardize their childhood development based on my desire to reveal my true identity and the condition I live with each and every day of my life. It's not fair to them to make this decision while they are so young. So I won't.

At this point, I have chosen to move forward with the blog anonymously. I just feel like it is the right thing to do for my family - not just my kids, but for my husband too.

Journaling your journey of life with bipolar disorder

After I experienced my second manic episode over Christmas in 2005, my Dad had a brilliant idea. It was something so simple, yet so tremendously important in the process of helping us to figure out what was going on with me. Over the course of five months I had been put on so many different medications and the doses were constantly changing as we worked to find what ultimately would be the one to "fix" me. To try to keep track of it all, my Dad suggested that I keep a small daily journal with details on just three things: what medications I took that day, any side effects I was experiencing, and how I was feeling. I began in April of 2006 and have continued today. Those journals are my life in a nutshell. I have looked back through them many times through the course of managing my illness to recall the medications and dosages I was on at different points in my history of living with bipolar disorder. They have been an incredible resource to me and the doctors I have seen over the years. I am forever grateful to my father for coming up with this idea.

The amazing thing about these journals (I have 5 small notebooks filled by this point) is that when I open to a page and read the entry from that day, I can be instantly taken back to that day simply by reading the words that are written on the page. I usually stuck to one page a day, so as not to make the process too time-consuming that it would seem like a chore.

Most of 2006 was filled with pages of me describing crying spells and anxiety attacks. I get sad when I read those pages. But it also helps me to stay focused on my goal to stay healthy and balanced, so as not to have to experience that pain again. When I read my entries from the times I was in the hospital or from my days back at home immediately following the hospitalizations, I recall how much stress and heartache I caused my husband and family and I know that I don't want that to happen again.

Usually after a hospitalization when I'm working with my psychiatrist to get my meds back to a good point, I'll use a mood chart for awhile until I become stable. I tried to find the exact one I used online, but wasn't able to locate it. I did find an online mood chart that looks similar though. I'm pretty sure there has got to be an iphone app for a mood chart, but since I don't have an iphone I don't know for sure. I used to bring my completed charts to my doctor so that she could review them in our monthly sessions. She found them helpful, but I seemed to prefer my journaling technique, so I did both.

I find it therapeutic and over the years it has pretty much become a habit - something I do right before I go to bed. I do enjoy blogging, but it's nice to have my paper journals too. Something about putting a pen to paper I guess. My journals are an invaluable resource to me in documenting my struggles and successes over the years. Lithium may not always work for me, and in the future I may have to transition to a different med. It's nice to know that I have my history written down, from my viewpoint. It is something that can never be taken away from me.

Do you keep a journal of your experiences managing your illness? If so, how do you think it has helped you?

Exercise - finding the right balance

Living with bipolar disorder I find that I constantly have to find a balance with everything. From my diet to my sleep to the amount of exercise I get on a daily basis, all these things affect my mood and have to be carefully monitored to keep me "in the middle" as my Dad describes it. I'm like my own personal see-saw, and the goal each day is to make sure that it stays as close to horizontal as possible. In a future post I'll get into sleep, but for this one I wanted to focus on exercise because it is at the forefront of my mind lately. I decided that I wanted to lose my squishy mid-section - leftover from having two bouncing babies who grew inside me - and in order to do it I thought I'd train to run a 5k. I've never been very good at running, but it seems like such a great exercise to do when trying to lose a little bit of weight. Also, I felt it would be a good goal to say that I accomplished.

I recruited one of my best friends to join me and I began training using an online training tracking website called Active.com. It is so motivating for me to use the site to track my progress and so far I've done a really good job of keeping up with the program I found online: The Cool Running Couch-to-5-k training program. You basically jog/walk on increasing intervals for six weeks until week seven when you're jogging 2.5 miles at a time. I am really excited about it.

This morning during my jog/walk, I realized that it felt really good and that when my timer beeped that the two minutes were up and it was time to walk, I felt as though I could actually continue jogging. Pretty good sign, right? Hopefully the program will work for me and I'll be able to jog the entire 3.1 miles for the race in October.

What I need to be careful about with exercise is that sometimes it can catapult me into a hypomanic state. I've discussed it with my psychiatrist and we came up with techniques to help me recognize the mood lift and how to make sure it doesn't go too high that it leads to mania. For me I have found that sticking to about 30-45 minutes of aerobic exercise a day, done in the morning or early afternoon, is the best way for me to keep my mood at a good level. When I exercise I feel strong and it also helps me to watch my diet more closely because after putting in all that effort to burn calories, I usually don't want to negate it then.

Yoga and pilates have also been other forms of exercise which I have enjoyed tremendously. When I was first diagnosed and was having trouble sleeping, my parents gave me a yoga DVD for Christmas that year. It's called zYoga and was a tremendous help to me in dealing with my insomnia. The woman in the video is so calming and has such a relaxing voice, it became a wonderful sleep ritual for me. I practiced prenatal pilates when I was pregnant with my daughter last year and I truly believe that the class helped me to recover so quickly and easily from childbirth that I would recommend it to any pregnant woman looking for a prental exercise class. It became more and more challenging as the weeks went on, but I found that I gained only 24 pounds with that pregnancy compared to the 43 I gained with my first pregnancy when I did not exercise.

There have been numerous studies on the benefits of exercise for people struggling with mood disorders. If you can find even ten or fifteen minutes a day to walk outside, I am sure that you will quickly feel the benefits and will continue to notice them if you commit to it.

Given today's busy lifestyles, how do you find time to exercise on a daily or weekly basis? Do you think it helps you to manage your moods?

Full disclosure

So in beginning this project I decided to consult with my husband to make sure that I had his full support. He knows that I have been wanting to do something like this for a long time, I just wasn't at the right point in my life to be able to do it until now. I believe that I am a strong writer.  People have told me that I am an excellent writer actually. But in my opinion, there is one huge roadblock standing in the way of my blog becoming a success: full disclosure. Coming out to the world and saying that you have bipolar is such a scary thing. There is so much stigma attached to the label of bipolar that it makes it almost impossible for most people to admit that they have the diagnosis at the risk of losing friends or losing their job. Future employment is probably the major reason my husband and I are nervous about unveiling my identity completely.

As an avid blog-reader, I myself know that unless a blogger shows their true identity and describes his or her life in detail and with pictures, their blog is not all that interesting or captivating. I want to be able to share without strings attached and at this moment this isn't possible. Not without my husband's approval and he did make a valid point when we talked this evening. He wants me to think about it more.

I've had what I would consider to be a successful career so far as a Recruiter and, although I'm a stay-at-home-mom right now to our two kids, I'd like to work again. I am easily described as a Type-A personality who craves challenges and goals to exceed, so I predict that there will be a time in the next couple of years that I will want to do some type of recruiting work and therefore I would need to be hired by someone. Whether that be a private client hiring me to do some freelance recruiting, or a company hiring me as a contract recruiter, it's all I've known career-wise for the past 10 years and it is work that I do well and enjoy. So will coming out to the public that I am bipolar hurt my future chances of employment?

I guess in a sense I'm also wondering, "Will my diagnosis revelation change the way people in general feel about me as a person?" I really hope not. That would truly be sad.

Only time will tell. I'm going to consult a few more people who I respect given their situations surrounding bipolar disorder and disclosure, in addition to my parents and brother, to collect some opinions which will help me to make this very difficult decision.

Have you ever been scared to disclose to friends or colleagues/bosses that you are bipolar? How did you handle the decision?

National Pregnancy Registry

My daughter turned 8 months old yesterday. About two weeks ago she started crawling and just yesterday she started babbling non-stop. I am continuously amazed at how quickly she is growing and changing. And I am intensely grateful that she is a happy, healthy baby. I was hospitalized for bipolar mania when I was just five weeks pregnant. My husband and I had been trying to conceive our second child for seven months and it had finally happened, only to cause me such excitement that I couldn't sleep which lead to my mind racing beyond belief forcing him to sign me into a psych ward for four days. I had been working closely with my psychiatrist to come off the Lithium for the first trimester once I found out I was pregnant and then once the mania took over from the excitement of finally becoming pregnant, I continued to refuse medication because I thought I was doing what was best for the baby growing inside me.

Looking back now I know how very wrong I was.

The main risk that the baby faced if I stayed on Lithium was Ebstein's anomaly, a heart defect. The general population has about a 3% chance of this particular congenital heart condition, and the risk increases to around 6% for a person taking Lithium during pregnancy.

In my case the benefit of staying on medication greatly outweighed the risks of me becoming manic and needing hospitaliztion, and I definitely knew this having done a ton of research beginning back before I became pregnant with my son. But with his pregnancy I was able to somehow stay medication-free throughout those nine months and one month after his birth. And I think I was feeling some mommy-guilt in wanting to give this second baby the same drug-free environment in which to grow and thrive. It only seemed fair.

After spending four nights and five days in a psychiatric facility near our house, I was finally released to the care of my regular psychiatrist after being stabilized on Haldol via injections because I was very resistant to oral medications at the beginning of my hospital stay. They also used Zyprexa since historically I responded so well to it. Of course I was scared to death about how these medications were affecting the baby's development, especially because there is so little research out there on the use of a-typical antipsychotics during pregnancy.

This is what lead me to find the National Pregnancy Registry via an online search. They are collecting information from women who have taken certain antipsychotics during pregnancy and after childbirth to hopefully shed more light on the safety of these medications during pregnancy. They also need women who are currently pregnant and NOT taking these medications, to serve as the control. If you know someone who is willing to participate in this on-going study, please direct them to the site to sign up to join.

It is easy to participate - just a series of brief phone interviews and some completed paperwork releasing medical records is all it takes. They do a baseline interview during the beginning of the pregnancy, a 7-month interview, and a postpartum interview. Simple. Once you finish it will give you a good feeling knowing that you are doing something to help improve the quality of healthcare for pregnant women in the future.

A little history - the first half

In writing my blog posts, I'm not planning on going in chronological order, because that would be kind of boring, don'tcha think? The first half is about my first two hospitalizations which occurred within two weeks of each other and were before it was determined that I was Bipolar. The second half details my second two hospitalizations which occurred after the birth of my first child and during the first trimester of my second pregnancy.

However, I do think that it would be helpful to give a quick little summary in order to kick-off the launch of my blog, so here goes. Back at the end of 2005 I suffered my first mental break when I became manic beyond belief and had to be taken via ambulance, screaming and strapped down to a stretcher I might add, to the hospital because my poor husband had no clue whatsoever as to what was happening to me. I had barely slept a wink that entire week and it all came to a head on Sunday night. Two nights in the psych ward, a week off from work to recoup, my first visit to a shrink who attributed the entire episode to sleep deprivation and told me I could discontinue the Risperdal I was taking, and yes folks, believe it or not, I was back at work the following week.

Two weeks later when I relapsed and suffered another manic episode, it was clear that something really was wrong with me and it wasn't just sleep deprivation. But with no real history of mental illness in our family, we didn't know where to start to begin seeking answers. My parents spoke with some close friends of theirs who were able to find a recommendation for a psychiatrist in Florida and got me an appointment while I was there with my husband visiting over Christmas. Spending Christmas Day and the two days after in another psych ward was not my idea of a holiday. In fact, that Christmas was probably one of the worst days, if not the worst, day of my life.

After emerging from that second hospitalization, and sitting down for just an hour with the psychiatrist we were referred to, he was able to determine that there was a very strong likelihood that I was suffering from Bipolar Disorder and that I needed to start taking an anti-psychotic medication immediately to bring me down from the mania that I was still apparently experiencing. That evening I began taking Zyprexa.

Once back in Virginia and back at work, I started having anxiety attacks on an almost daily basis. The feeling of waves of panic coming over my body were so intense that it became impossible for me to be effective at work. I was forced to resign from my job as a successful employment agency recruiter and in turn felt like I had lost part of my identity. Crying spells then became part of my daily routine, in combination with the anxiety, and I remember wondering if I were going to be feeling that way for the rest of my life. It was a scary time for me. I don't ever want to go back to that. Ever.

I remember back in the fall of 2006 when I was incredibly against going on Lithium, but yet, at my wits end with the way I was feeling I was ready to give in and try anything with the even the slightest probability of helping me feel like my old self again. For pretty much the entire year I had been depressed and anxious and thus I had reached a turning point. My psychiatrist at the time had been suggesting Lithium for a few months, but it just seemed so final, so imperative. But who was I kidding? It was obvious to the three different shrinks I had seen, one being a renowned specialist in the field, that I was bipolar and that a mood stabilizer was what I ultimately needed to function at a normal level.

So fine. I caved into going on a Lithium regimen the day after my husband and I had a consultation with the specialist. He didn't even see patients any longer, only did continuing research in the field. So when my dad's friend was able to get us an appointment as a favor, we jumped at the chance. At the time I was on Prozac and Zyprexa, along with Ativan for anxiety and Ambien for sleep. Nice cocktail of meds, right? The Prozac caused some suicidal thoughts, though nothing I ever remotely was going to act on. So my doctor had cut that dose back quite a bit. After seeing the specialist I started on Lithium and my regular doctor began to wean me off the Prozac and Zyprexa one at a time until I was eventually just on Lithium.

Within a matter of four months I found myself feeling like the old me again. I was ready for a fresh start and finally felt more confident. It was what I needed in order to launch a job search and in a few short weeks I landed a job as a corporate recruiter for a Fortune-500 company and I couldn't wait to get started.

My inspiration for this blog

Bipolar I is my diagnosis but I try not to let the label get to me too much. I definitely think about it on a daily basis, but I'm not embarrassed or ashamed of it anymore like I was back when I was first diagnosed. Sure, the stigma is still there, but it's beginning to fade. I hope that by putting it out there and by telling the world that I am living with this illness, and living a very fulfilling life I may add, I may inspire other women to seek the help and support they need in order to be able to have a family of their own if that is what they are wishing for. I was at an extreme low and was so devastated by the state of my mental health that I had convinced myself that I may never get the chance to become pregnant to start a family with my husband. But once I found the right medication and the right doctor, I was able to make my dreams of an amazing family come true and it was worth all the struggles and heartache, the four hospitalizations and the recovery time, to get where I am at this moment right now. Lately at night when I am drifting off to sleep, I find that I am reminding myself how lucky I am to have an incredible husband who loves and supports me, two beautiful healthy children, an amazing family surrounding me in my parents, brother and his wife, and in-laws and sister-in-law in addition to an extended support system of loving friends whom I trust so much. It sometimes doesn't seem real. But I am living proof that just because a person is living with a mental illness doesn't mean they can't work hard to manage it well and this blog is my way of giving back. I want to take the past six and a half years and share what I have learned from my journey to somehow help other young women who may have been feeling the way I was feeling back at the beginning of when it all started for me.

If you like what you are reading, and know someone who could benefit from my experiences, please, pass on the link to my blog. Over 5 million Americans live with this illness, so chances are within your family, friends, work, school, or church you probably know someone who may be suffering. They may find comfort in reading a story of someone who is doing better than average at managing it. I know I always do.